Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an infrequent cause of systolic heart failure that can affect women in the last month of pregnancy and up to five months after delivery. While PPCM is a type of dilated cardiomyopathy, the etiology of this condition remains largely unknown.1 Given the infrequency with which PPCM is encountered and the potential for this condition to be fatal, proper diagnosis and management is critical for reducing maternal and fetal complications, as well as assessing the safety of future pregnancies.

Case Presentation:

A 33-year-old gravida 3, para 1, abortus 1 (G3P1011) at 39 weeks and 5 days of gestation presented to labor and delivery with a complaint of new-onset headache and vaginal bleeding that began earlier that morning. Her medical and social histories were significant for chronic hypertension and a one-half pack per day smoking history. Despite persistently elevated blood pressure greater than 140/90 mmHg, the remainder of an evaluation for preeclampsia was negative. Clinical assessment of her vaginal bleeding was suspicious for abruptio placentae, ultimately leading to the decision to proceed with induction of labor. Subsequent arrest of dilatation and concerns for worsening abruption led to cesarean delivery of a live male. After an uncomplicated recovery, the patient was discharged home on the second postoperative day with a narcotic analgesic and a beta blocker, which was started during her pregnancy and continued as treatment for her chronic hypertension. On the sixth postoperative day, she presented to the emergency department with severe shortness of breath. Physical examination was remarkable for tachycardia, bilateral basilar crackles on chest auscultation, and 1+ edema in her lower extremities. Chest CTA demonstrated no evidence of pulmonary embolism and cardiac MRI showed no evidence of myocardial scarring, fibrosis, or pericarditis. Her NT-proBNP (22,555 pg/ml) and cardiac troponin I levels (0.172 ng/ml) were significantly elevated, and she was diagnosed clinically with acute heart failure. Right heart catheterization and tissue biopsy were considered, but not performed. An echocardiogram revealed an estimated left ventricular ejection fraction (LVEF) of 25 to 30%, consistent with the diagnosis of PPCM.